Sciatic nerve injury rehabilitation

The sciatic nerve includes many nerve roots, but as long as there is a problem with any nerve root, the sciatic nerve will develop a very serious disease, and it will have a great impact on our lives. Generally speaking, as long as the nerve is not broken, it can be recovered. The sciatic nerve is the same. There are some methods to make it recover. So what is the rehabilitation of sciatic nerve injury?

The sciatic nerve is composed of the L4, 5 and S1, 2, 3 nerve roots. The injury is often caused by firearms injuries to the thigh or buttocks. Sometimes hip dislocation and pelvic fracture may also be accompanied by sciatic nerve injury.

Clinical manifestations: Posterior dislocation of the hip, knife wounds to the buttocks, surgical injuries to gluteal muscle contracture, and intramuscular injection of drugs into the buttocks can all cause high-level injuries, resulting in paralysis of all muscles in the posterior thigh, calf, and foot, leading to inability to flex the knee joint, complete loss of movement function of the ankle joint and toes, and foot drop. There is loss of sensation in the posterolateral calf and foot, and neurotrophic changes in the foot. Because the quadriceps muscles are healthy, the knee joint is straight and the patient walks in a striding gait. If the injury is in the middle or lower part of the posterior thigh, the muscles of the posterior thigh are normal and the knee flexion function is preserved.

Examination: Electrophysiological examination: Typical neuroelectrophysiological manifestations are slower nerve conduction velocity on the affected side, decreased amplitude, prolonged latency of F wave or H reflex; prolonged latency, decreased amplitude, and prolonged interwave interval of somatosensory evoked potential; electromyography of muscles innervated by the sciatic nerve mostly shows loss of nerve potential while the healthy side is normal. The electromyography of the quadriceps muscle on the affected side is usually normal, and the slightly stronger knee tendon reflex is also related to the normal function of this muscle and the weakened function of the antagonist muscle. These manifestations are helpful in distinguishing Guillain-Barré syndrome from poliomyelitis.

Diagnosis: History of trauma or injection, paralysis of muscles below the thigh or below the knee; paralysis of muscles in the area innervated by nerve branches, partial loss of sensation in the area below the calf, and electromyography can confirm the diagnosis.

Treatment: Buttock sciatic nerve injury is one of the most difficult to treat and least effective peripheral nerve injuries. The damage to each segment is closely related to the local anatomy. In case of drug injection injury, neurolysis should be performed as soon as possible, and the patient should be repeatedly flushed with saline. Hyperbaric oxygen therapy after surgery can effectively promote the regeneration and repair of the damaged sciatic nerve. The younger the patient is and the earlier the surgery is performed, the better the effect will be. In case of sharp injuries such as cutting, a primary repair should be performed with end-to-end anastomosis of the outer membrane, and the patient should be fixed in the hip extension and knee flexion position for 6 to 8 weeks after surgery. In case of sciatic nerve injury caused by hip dislocation or pelvic fracture, the patient should be repositioned and decompressed early to relieve compression, and observe for 1 to 3 months before deciding whether to explore the nerve based on the recovery situation. In case of firearm injury, only debridement should be performed early, and exploration and repair should be performed 3 to 4 weeks after the wound heals. Late-stage foot and ankle functional reconstruction can improve limb function.